03070065 CITY OF CUPERTINO , a^"�
BUILDING DIVISION PERMIT C0NTRA.CT,#ab,4FURMATION:`;,
BmLDING ADDRESS: YARON & NANETTE VIDAN-PELE """"°03070065
AP RICHWOOD MR.
OWNER'S NAME: PERMIT ISSUE DATE
E: SANITARY"0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO ELO PLUOMB MEOCH
300 LICENSED CONTRACTOR'S DECLARATION
qIobDescrip tion
FF 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing -�
' a� with Section 7M)).f Division Sof the Bu,inasa and Pmfoodom Code,and my license is `
y in full force and effect.
,n4 Ueeaae Class Ld.. NEW S P A
'=a Dau Cuntreew, u
e 7W ARCHITECTS DECLARATION
t < 1 undcntand my plans shall be used as public records
>�
ha License]Piratical onel J
OWNER-BUILDER DECLARATION I
COO hereby reaso affirm that 11. exempt from we Convector's :Any Law for Ibe
00 radowwhich ire requires
a. roust 7onstr Business and Proimprove,
dioitlah,or:Any ally or county
-
e m which rcyuircs a patted toconstruct,the
plug i t for such
h Permit's or repair any sWctum
�zy
prior miu issuance.also reyvircs the applicant for such pesmilm file asigneJ nelemenl
G
IMI hei.licensed pumamlothe provisions or the Coniamu'sLicense Law(Chapter 9 Sq.Ft. Floor Area Valuauen
�$
(commencing with Section 7003)Of Division Sof the Business and Pro(cminns Cooed or
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that he is exempt Ibemfrom and the bask far we alleged exemption.Any vmladan of 36908022 . 00
Section 7071.5 by any applicant for it permit subjects Inc applicant a a civil penalty of APN Number Occupancy Type
not more than Eve hundred dollars($500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work.and the structure is not intended or offered foaale(Sec.7044,Business iUi FUUND
—
and Profeasions Code:The Canumau.License Law data not apply or an owner of 10 2 - PIERS AAeWP6d Inspections
property who builds or improves Hereon,and whodom suchwork himself m through his
own employees.provided shat such improwmcnu see not intended arartercd forak.IL 103 — UFER
however,the building or improvement is sold within one your of completion,trainman.
builder will have the burden of proving that he did not build or Improve for purpose of 104 - REBAR
61.'7' 105 - ANCHOR BOLTS
❑1.as owner of we propeny,am exclusively contracting with licensed contractors Or 106 — SEWER & WATER
construct the project(Sec.7044,Business and profusions Cade:)The Connector's Li-
cense Law does not apply to an owner of property who holds or improver themon,and, 202 - UNDERFLOOR PLUMBING
who comment for such projects with a conuacmr(i)licc aedpameom useciumm e.
4necLaw. 203 - UNDERFLOOR MECHANICAL
I.an p under Sec. .BkPCfor ore on 204 - UNDERFLOOR FRAME
° et a" 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATI NDECLA0.A
I byaM underpemltyofperj onca(Ne fo owing declarations: 301 — ROUGH PLUMBING
—" IhawandwillmaintainsCerible e.c.andtoself-Insure forWorkeisCompcn. 302 — TUB & OR SHOWER
moon,u provided for by Section 7700 of Nc Labor Code,far be performance of tire 303 - ROUGH MECHANICAL
wmI terwdan tho permui,issaed' 304 - ROUGH ELECTRICAL
❑1 have and will mainuin Worker's Compensation Insurance,as required by Section
3700o(the Lanm Cadafor Neperformanceaftheworkforwhich Nisprnallisixond. 305 — FRAME
My Worker's Compensation lnsunnce carrier and Policy number are: 306 — HOLDOWNS
Carrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 — SHEETROCK
crnk section need not he cropland if Ne Noun is for one hundred dullam(glol) 309 - EXTERIOR LATH
1 ecro.7 310 - INTERIOR LATH
eceni(y Nat in Nc in any manneor as work for which this permit is issued,I shatlenta not
Lawsof any Noon in any manncrwasmheeomc subject the Worken'Compenatlan 311 — SCRATCH COAT
Law.of California.Wm
Applicant313 - ROOF NAIL
NOTICE TO APPLICANT:IL after making this Ccnifimm of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Conformation previsions of the Lahor Code,you most
OZ fonhwid,complywithsuchprovisionsorthispermitshallbedeemedrevoked. 502 — FINAL PLUMBING ENERGY
z 0 CONSTRUCf10NLENDING AGENCY 503 - FINAL MECHANICAL ENERGY
EI-r4 Ibarony am,.Natthem isacon.ueionlending agenrytorteperformanceof 504 - FINAL BUILDING ENERGY
Ban,work forwhich this p muoissmd(sea.J097.ck.c.)
W Lender's Name 505 - FINAL ELECTRICAL
aA z LcnaerkAaareas 506 - GAS TEST
o I certify Net 1 have read this application and sure that the above information is 507 - FINAL PLUMBING
comet.1 agree to comply with all city and county ordinances end sou laws relating u
OU wilding construction,and hereby immorizerepresentatives ofthis city toenter uponthe JFIMECCAL
shove-mentioned proially for inspection purp=L(We)agree to ave,indemnify and keep harmless the City of Cupertino against 0 9
y liabilities,judgments,costs andeapcnacswhichmeyinanywayeccmcegainstsaidCity 5 NG
V in�+ APPLICeeNTeof the UNDERSTANDf this
rNUrmit
ILL C LY WITH ALL NON-POINT Issued by:5 C WORKS Date
SOUR REGULATI N .
Re-roofs
n of Applicant/Contmetorl u
HAZARDOUSMATER LSDISCLOSURE Type of Roof
Will Iheapplicantur(uture budding current atom or handle woodous material
as dcamcd by the Cuper ins Municipal Cade.Chapter 9.12.and the Hcalth and Safety
Code,Section 25532(.)? // All roofs shall be inspected prior to any roofing material being installed.
❑Yesa
Will the applicant or Noun building accupam use equipment or dcvices which If a roof is installed without first obtaining an inspection,I agree to remove
u hazardous air comami U as dcfincd by the Bay Arca Air Qualily Managcm..I all new materials for inspection.
otricL?
❑Yes
I have read the numerous Materials requirements under Chapter 6.95 or the Cabral,
nia Hc.IN ffi Safety CWc,Sceuws 25505.255]7 and 255 I undcnund thatifNc wiling
due,not enyteripy new a m t,Nel't u m mo ar 1' m stud y Ibe occupant of Ne
mq ire c ich mus crp' tui cc of 'Ocate of occupancy Signature of Applicant Date
Owner r Norivcdegcnt All roof coverings to be Class"B"or better